Sick leave due to back pain in a cohort of young workers.

PURPOSE: Evidence on risk factors for sick leave from prospective studies in work settings is limited. Furthermore, most available studies focused on workers with substantial low back disorders. These studies consistently report that physical work factors constitute a hindrance to work. However, it remains unclear whether the same risk factors are relevant in workers with less severe conditions or in early phases of the development of back pain. Therefore, this article aims to study risk factors for the occurrence of sick leave due to low back pain (LBP) among young workers with no or a modest history of back pain. METHODS: Participants were 716 young healthcare or distribution workers with no or minimal antecedents of LBP in the year before inclusion. We investigated the role of potential physical, psychosocial and individual risk factors at baseline on the occurrence of sick leave due to LBP 1 year later. To this purpose, we used Cox regression with a constant risk period. RESULTS: Six per cent (95 % CI 4.1-7.6) of the workers reported sick leave 1 year later; they accounted for 12 % of the sick-leave days independent of cause. A non-stimulating psychosocial work environment turned out to be the strongest risk factor for sick leave due to LBP (RR 6.08; 95 % CI 1.42-26.07). Physical factors were not predictive. CONCLUSIONS: In the early phases of back pain and in less severe conditions, the main benefit of interventions lies in targeting the organisation and design of jobs to create a challenging professional environment.

The role of physical workload and pain related fear in the development of low back pain in young workers: evidence from the BelCoBack Study; results after one year of follow up.

AIMS: To study the influence of work related physical and psychosocial factors and individual characteristics on the occurrence of low back pain among young and pain free workers. METHODS: The Belgian Cohort Back Study was designed as a prospective cohort study. The study population of this paper consisted of 716 young healthcare or distribution workers without low back pain lasting seven or more consecutive days during the year before inclusion. The median age was 26 years with an interquartile range between 24 and 29 years. At baseline, these workers filled in a questionnaire with physical exposures, work related psychosocial factors and individual characteristics. One year later, the occurrence of low back pain lasting seven or more consecutive days and some of its characteristics were registered by means of a questionnaire. To assess the respective role of predictors at baseline on the occurrence of low back pain in the following year, Cox regression with a constant risk period for all subjects was applied. RESULTS: After one year of follow up, 12.6% (95% CI 10.1 to 15.0) of the 716 workers had developed low back pain lasting seven or more consecutive days. An increased risk was observed for working with the trunk in a bent and twisted position for more than two hours a day (RR 2.2, 95% CI 1.2 to 4.1), inability to change posture regularly (RR 2.1, 95% CI 1.3 to 3.5), back complaints in the year before inclusion (RR 1.7, 95% CI 1.1 to 2.8), and high scores of pain related fear (RR 1.8, 95% CI 1.0 to 3.1). Work related psychosocial factors and physical factors during leisure time were not predictive. CONCLUSION: This study highlighted the importance of physical work factors and revealed the importance of high scores of pain related fear in the development of low back pain among young workers.

Risk factors for first-ever low back pain among workers in their first employment.

BACKGROUND: Low back pain has been estimated to be the most costly ailment of people of working age. Both work characteristics and individual factors have been identified as risk factors. The first interaction between work characteristics and individual factors occurs when workers start in their first job. AIMS: To investigate work-related risk factors for first-ever low back pain in young workers in their first employment. METHODS: A cross-sectional analysis was performed on 278 young workers in their first employment and without a history of low back pain prior to working. Work-related physical factors, psychosocial work characteristics, individual variables and first-ever low back pain were queried by means of a questionnaire. RESULTS: About half of the workers who developed low back pain after job start did so in the first year of employment. An increased risk was observed for (i) long periods of seated work [relative risk (RR) = 3.2, 95% confidence interval (CI) = 1.6-6.4]; (ii) more than 12 flexion or rotation movements of the trunk per hour (RR = 3.0, 95%CI = 1.4-6.4); and (iii) more than 3 years seniority in a job involving lifting more than 25 kg at least once an hour (RR = 3.7, 95%CI = 1.4-9.4). As to psychosocial work characteristics, first-ever low back pain was associated with a combination of low psychological job demands and low supervisor support. CONCLUSION: Work-related physical factors and psychosocial work characteristics should be considered as risk factors for first-ever low back pain. First-ever episodes of low back pain are common in the first year of employment. This may reflect a lack of work experience or training.

Back pain and its correlates among workers in family care.

In order to assess the prevalence of back pain problems among family care workers, and the association of back pain with selected variables, a cross-sectional survey among the 4723 employees of the largest Flemish organization for family care was conducted. A self-administered questionnaire comparable to the standardized Nordic questionnaire on musculoskeletal symptoms was distributed to all employees of the organization. The response rate was 90 per cent (n = 4256) and the study population was almost uniformly composed of females (99.8 per cent). The period prevalence (12 months) amounted to 63 per cent (95 per cent CI: 61.7-64.6) and the point prevalence to 18 per cent (95 per cent CI: 16.5-18.8). Among the respondents suffering from back pain during the past year, 72 per cent suffered from repeated episodes of pain. In 82 per cent low back pain was involved. Twenty-nine per cent of the complaints interrupted their work during the past year, yielding a total number of 23,396 days of sick leave. The mean sick leave for back pain was 36 days and the median 15 days. The frequency of back pain was found to vary according to the regional departments to which the employees belonged, some sections experiencing up to 36 per cent higher period prevalences than the units with the lowest figures.(ABSTRACT TRUNCATED AT 250 WORDS)

Health and social inequities in Belgium.

This paper presents two different yet complementary on-going studies related to the understanding of the mechanisms leading to social inequalities in health. The first part is devoted to a differential morbidity survey held in southern Belgium. It confirms that striking differences exist in the period around birth between social categories, and between the three districts under study. In a multivariate approach, differences remain between the social categories and between the district samples, which classically studied socio-demographical, behavioural and medical characteristics cannot fully explain. The role of cultural factors is analysed and discussed through the concept of 'health culture' and alternative hypotheses are reviewed in the light of the results. The second part reviews the studies conducted on the so-called avoidable mortality in the EEC and more specifically in Belgium. The concept of avoidable mortality is discussed, as well as its utility from the standpoint of the present concern on social inequalities. Differences between EEC countries are large, and even within Belgium there are important disparities between the districts. The role of health care supply has not been demonstrated yet in these two contexts. For Belgium, it appears that a major part of the unequally distributed mortality is constituted by causes of death considered as avoidable. Moreover, the most discriminating causes of death are overrepresented in socially deprived districts. The two perspectives are confronted in order to delineate perspectives for future research and operational outcomes for policy making and interventions.

The effectiveness of repeated cardiopulmonary resuscitation training in a school population.

At the end of a study program, evaluating the feasibility and the effectiveness of a unique training session on a school population, the majority of the students were asking for additional training opportunities. We therefore set up the present study with the purpose of evaluating skills, knowledge and attitude concerning CPR, after respectively one and two training sessions. 265 students from 4 different school levels were trained. 6 months later 134 answered a questionnaire and were again trained in CPR, 129 students answered the same questionnaire and were tested for their skills in CPR. Ten months later 75 students who had two training sessions answered again the questionnaire and 65 among them were tested for their skills. The two training sessions were identical, given by lay teachers priorly instructed in CPR, and consisted of a video-program and practical demonstration, followed by individual practice on training manikins. Both training sessions lasted 100 min. Evaluation of skills was performed by emergency physicians not involved in the training. Seventeen different items, representing each step in CPR were scored. Repeated training induces significant improvement of total skill scoring, without significant difference between boys and girls, but with improvement of scoring with class level. When looking at the different steps, the improvement in scoring is most impressive in certain steps which scored poorly after one training session, such as backward tilt of the head, a keystone in CPR. The steps concerning mouth-to-mouth breathing and external thoracic compressions reach, 10 months after the second training, an average of 1.6 out of 2 (80% correct) as compared to 1.44 out of 2 (71.9% correct) after one training. Knowledge concerning CPR does not increase significantly after the second training session. The time lapse of 10 months since the second training session may have played a role, although the methodology excluding interactive instruction may also explain this discrepancy. The influence on attitude shows that fear to apply CPR increased significantly after one training session and does not significantly lower after the second training. This attitude seems to be rather person-linked, for no correlation was found with age, theoretical knowledge or practical skill scoring. We have no way of knowing whether the statement concerning fear to apply CPR will correspond with such an attitude when confronted with a concrete emergency situation.

Availability of psychotropic drugs and suicidal self-poisoning mortality in Belgium from 1971-1984.

Trends in completed suicide by solid or liquid substances in Belgium were investigated for the period 1971-1984 in relation with data about sales of psychotropic drugs. Mortality rose sharply between 1973 and 1980 (from 21.1 per million population of 15 years and older to 52.2 in males and from 26.7 to 61.7 in females) and decreased slightly thereafter. No apparent coincidence with the availability of psychotropic drugs was found, and the increasing risk of suicidal persons dying at home suggested an increase in the severity of the attempts until 1980. However, incidence changes could also have affected these trends. The evolution in accidental and in suicidal hospital rates suggested that emergency care had improved. Although barbiturate sales decreased continuously (from 46.7 packages per year per 100 population in 1974 to 28.5 in 1984), these drugs still account for a high proportion of fatal self-poisonings (23%) in Belgium. Possible shortcomings that could affect the validity of our findings are discussed.

Recent trends in methods of suicide.

Trends in completed suicide by method were analysed for Belgium between 1968-1972 and 1978-1981, using the information reported on death certificates. Around 1980, hanging was the most preferred method of suicide in both sexes, followed by firearms in males and poisoning by solid and liquid substances in females. Between 1970 and 1980, rates for all but one method (domestic gas) increased. The largest changes among men were seen for firearms and for poisoning, accounting respectively for 43% and 33% of the overall increase. For women, 48% of the rise was attributable to poisoning and 24% to drowning. The choice of method was seen to be influenced by age: hanging and drowning were the preferred methods for older people, whereas poisoning was the most popular among younger adults. The male-female ratio decreased for firearms and was reversed for poisoning and drowning. These findings are compared with trends in other industrialized countries, and the possibilities for suicide prevention by reducing the firearms and poisoning rates are discussed.

Epidemiological aspects of suicide among the young in selected European countries.

Trends in reported suicide rates were analysed for the ages 5-24 years in 21 selected European countries in 1970-74 and 1980-84. In children the precision of the rates was found to be low though there appeared to be a trend to increased suicide in boys. In adolescent and young adult males, however, there was a definite increase in suicide over the period studied, and this was much more marked than in females, in whom the rates had declined in eight countries. The Belgian situation was investigated in detail. Increases were most pronounced in 20-24 year-old males. Around 1981, about half of youth suicides were committed by firearms and medicaments, and these methods showed the largest increases in risk. The estimated under-reporting error diminished with increasing age and over the past ten years. It was larger in females, but did not bias the trends substantially. On the aggregated level, youth suicide was found most strongly associated with indicators of anomie and social isolation. The relevance of these findings in the search for determinants and for preventive strategies is discussed.

The geographical pattern of methods of suicide in Belgium: implications for prevention.

The geographical variation of reported suicide among the 43 Belgian districts was analysed for each method of suicide in both sexes and in two time periods: 1968-72 and 1978-81. Different descriptive methods were used to assess the patterns and changes in method-specific indirectly standardized death rates. It appeared that the overall suicide pattern was not always a good reflection of the method-specific patterns. Moreover, these seemed consistent in time and between sexes. Two important methods, which could be partially influenced, showed a remarkable concentration in some southern districts: suicidal poisoning by solid and liquid substances (in both sexes) and the use of firearms (in males). Drowning was much more concentrated in the West of the country and jumping was especially frequent in Brussels. Possible explanations and the relevance of these findings for prevention are discussed.

Birth cohort analysis of suicide mortality in Belgium 1954-1981 by a graphic and a quantitative method.

The effect of birth cohort upon the recent increase in Belgian suicide trends was analyzed by two techniques: a graphic display and an Age-Period-Cohort (APC) modelling procedure. Both suggest an analogous pattern: suicide mortality steadily increased within successive male cohorts born after 1920 and within female cohorts born even before 1900. Between 1970 and 1980, period related factors seem to have operated independently. Every technique of cohort analysis however has important interpretational limitations because of the variable interplay between age period and cohort factors. As a consequence, explanations remain very tentative, Notwithstanding its rather poor etiological power in suicide epidemiology, cohort analysis is very useful in the more accurate description and prediction of suicide trends.

[Avoidable mortality in Belgium]. / La mortalité évitable en Belgique.

The concept of avoidable mortality leads to an attempt at using specific mortality rates as output measures of health services. The analysis covered 43 Belgian districts between the years 1974 and 1978. Two Belgian areas were compared along a dimension defined by two axes of a correspondence factor analysis: Flanders which is associated with low SMR of avoidable mortality and Wallonia which has high rates. The persistence of high mortality in Wallonia was confirmed. Factorial scores for each district were used as indexes for geographical heterogeneity. Variations in these indices, including patient consultation rates and technical medical procedures, remained even after adjustment for socio-economic differences.

The reliability of reported suicide mortality statistics: an experience from Belgium.

To assess the reliability of official Belgian suicide statistics in epidemiological comparisons on national and district level, various mortality indicators for suicide, undetermined deaths, accidental poisoning deaths and 'estimated' suicide in 1968-1972 and 1978-1981 were compared. Results did not reveal important bias on national comparisons by underreporting. But the biased distribution of undetermined deaths among the 43 geographical entities (districts) suggests that the assumption about constancy of underreporting is not always met and has to be checked if possible. Nevertheless, the numerical weight of the underreporting categories was not found heavy enough to bias the geographical suicide pattern in Belgium.

The rise of suicide mortality in Belgium between 1968-72 and 1978-81: age, sex and geographical characteristics.

Using directly and indirectly standardized mortality indexes in selected sex- and age groups, this paper analyses the age and sex characteristics and the geographical distribution among the 43 Belgian districts of the striking increase in Belgian reported suicide mortality between 1968-72 and 1979-81. Suicide mortality is obviously increasing more in females and in younger age groups, although the increase is still considerable in older age groups. The geographical pattern of generally higher mortality in central and southern districts seem consistent over time and between sexes but differences grow smaller over time, especially in females. A particular epidemiological situation for younger age groups is further suggested by our data.

Some aspects of the geographical mortality pattern of the Brussels population in 1970.

By means of routinely collected data and using the indirect standardization method, geographical differences in the mortality pattern of the Brussels population in the period 1969-1971, are described on a municipality level. The generally lower mortality for 'all causes' in southeastern municipalities and up to two times higher death rates in some northern and central municipalities are predominant findings. The presence of varying proportions of foreign born did not seem to influence the pattern. When examining specific causes of death (cardiovascular diseases, ischemic heart disease, cancer and violence) the pattern is less clear. Interpretation of these findings remains speculative. Striking analogies with the spatial distribution of possible determinants in other geographical studies of the Brussels situation are pointed out and will be analysed in forthcoming research. Nevertheless, this analysis does provide an idea of mortality differences with routine data and relatively simple techniques. This is important in guiding further research and in health care planning and evaluation.